COVID-19 is probably loose for good — better plan to manage it

© 2020 Peter Free

 

20 February 2020

 

 

Medical realists seem to agree that COVID-19 containment efforts have been a bust

 

Count me among them.

 

It is time to prepare to manage, rather than just contain this virus.

 

 

Here's why

 

A highly contagious, easily transmitted virus — which lacks obvious early warning signs — is probably always going to elude attempts to control its spread in densely populated areas.

 

Throw in COVID-19's suspected ability to spread itself before patient symptoms appear — and you have an essentially intractable containment problem.

 

 

Is transmission possible, even before symptoms appear?

 

Appears likely.

 

A group of Chinese physicians and researchers yesterday reported that:

 

 

We monitored SARS-CoV-2 [— the scientific name for COVID-19 —] viral loads in upper respiratory specimens obtained from 18 patients

 

(9 men and 9 women; median age, 59 years; range, 26 to 76)

 

in Zhuhai, Guangdong, China, including 4 patients with secondary infections (1 of whom never had symptoms) within two family clusters.

 

The patient who never had symptoms was a close contact of a patient with a known case and was therefore monitored.

 

A total of 72 nasal swabs . . . and 72 throat swabs . . . were analyzed, with 1 to 9 sequential samples obtained from each patient.

 

Higher viral loads . . . were detected soon after symptom onset, with higher viral loads detected in the nose than in the throat.

 

The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients.

 

© 2020 Lirong Zou, Feng Ruan, Mingxing Huang, Lijun Liang, Huitao Huang, Zhongsi Hong, Jianxiang Yu, Min Kang, Yingchao Song, Jinyu Xia, Qianfang Guo, Tie Song, Jianfeng He, Hui-Ling Yen, Malik Peiris and Jie Wu, Correspondence: SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients, NEJM [New England Journal of Medicine], DOI: 10.1056/NEJMc2001737 (20 February 2020) (excerpts)

 

 

Evaluate trying to imprison something, whose presence you cannot see.

 

 

Throw in another factual tidbit — misleading optimism generated by false graphing precision

 

Yesterday, I saw a report that Africa had (at the time) only one case of COVID-19.

 

The obvious question is "How does anyone know?" — given Africa's vast spaces and often overwhelmed medical infrastructures.

 

Given that thousands of airline flights were leaving China every week in January, does anyone really think that only one COVID-19 carrier made it to Africa?

 

For an obviously highly contagious — hard to detect — respiratory virus, the numbers game has been misleading from the beginning.

 

 

Now, pull the elements of this puzzle together

 

Sick and unsick people have been traveling out of China since December 2019, when the epidemic began.

 

So far, at least 26 nations report cases.

 

Do you think this qualifies as a successful containment?

 

 

What to do now?

 

BBC produced a video featuring a trio of experts, who think that it is time to transition into managing (rather than just containing) what appears to be a pandemic.

 

See:

 

BBC News, Can Coronavirus be contained?, YouTube (20 February 2020)

 

The group's point was that businesses need to figure out how to keep working with fewer personnel — and the economy needs to continue providing necessary goods and services to keep everyone afloat — while COVID-19 is running (presumably) rampant.

 

 

A key unknown is the virus's mortality rate

 

Early estimates (probably inaccurate) have been around 2 percent.

 

Flu is roughly 20 times less deadly.

 

You can imagine what would happen, if COVID-19's:

 

 

mortality rate really is that high

 

and

 

the virus does not mutate "down" to a less virulent configuration.

 

 

If those factors hold true, this will not be a trivial medical or societal management problem.

 

And no one, including the United States is prepared to deal with it.

 

 

The moral? — It is time to shift epidemiological gears

 

What was a containment challenge is now — more likely than not — a much more difficult medical and economic management one.